We should all be able to choose from similarly affordable, high-quality private health insurance policies regardless of our work status, or what we do for a living. Farmers, small business owners, factory workers, artists, healthcare providers, bankers, teachers, Iowans and Americans- working or not, should all have equal access to the best and most-affordable private health insurance choices.

You should receive the federal tax break to deduct the cost of insurance premiums instead of your employer getting the tax break to select health insurance for you.

Your employment choices should be focused on the best application for your skills and talents, and allow you to take advantage of educational, training or multiple part-time opportunities with the same benefits as those associated with full-time, traditional employment. Health insurance concerns should no-longer influence employment decisions.

Many people who get health insurance through their employer don’t realize that we all could have more affordable, high-quality health insurance policies and reduce the cost of healthcare if we were to choose our own policies in markets with access for all. It’s high time to reset the playing field so that insurance companies compete to have and keep each us as members. Then we as healthcare consumers are empowered with a vote and market influence each time we make a healthcare choice.

Multiple sources identify medical expenses as the number one cause of bankruptcies in the U.S. in 2019 (https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304901?journalCode=ajph&) and most of the affected families had employer-provided health insurance when they first became ill. If everyone got health insurance- somewhat like they do car or homeowners insurance- without any interference from employers, not only would more people have access to more affordable, high-value private coverage, but there would be more tax-payer dollars left over to keep people from falling through the cracks. We can end medical bankruptcies in a single legislative year with Suzanne’s proposals. No one should have to go medically bankrupt or have less-than-subsistence-level income to receive Medicaid services. Anyone of any income level should have access to Medicaid funding for healthcare services for an income-based fee any year they need it.

American workers may finally experience higher wages, further improvements in working conditions, and more quality-of-life benefits (like increases in paid-time-off) when health insurance is no longer part of employers’ benefit packages. The misguided Tax Cuts and Jobs Act that reduced the corporate tax rate more than necessary, and the currently low unemployment rate has set the stage for future Senator Herzog’s plans to help unleash wage increases at a faster rate than we have experienced in decades.

Health insurance monopolies will be dissolved with this plan. Insurance companies see the writing on the wall with people calling for “Medicare-for-All” or the end to private health insurance as we know it. Suzanne’s plan actually recognizes the value of a robust, competitive, and well-regulated, private health insurance market that will serve people better, and more effectively manage risk. Private health insurers will be a big part of the solution when the government finally does its job to monitor, regulate, and enforce the right policies (instead of propping up a failed employer-provided insurance system).

According to the Economic Policy Institute, “Eighty percent of health dollars are spent on just 19 percent of health consumers, and 50 percent of health dollars are spent on just 5 percent—presumably the sickest patients.” https://www.epi.org/publication/health-care-report/ So federal “re-insurance” or government support to help cover the healthcare costs of the most medically needy among us must be part of the solution to limit insurance premiums costs for the majority of Americans.

Ending employer-provided health insurance offers great gains for most American businesses. Not only will employers be able to focus on more efficient and effective business practices, but they will have more resources to optimize employee compensation, working conditions, and give employees more liberty to manage the real income and benefits they receive.

Decoupling health insurance from employment is a great move for the U.S. economy! Not only will this decrease the administrative costs of providing healthcare, but it gives state public health agencies, healthcare service providers, health insurers, and people who use healthcare services- incentives to work together to improve health and contain costs. The change will foster simplification of payment systems with more standardized prices for services, and less variation in insurance policies to make transaction processes easier.

My life’s work makes it an ideal time to be running for U.S. Senate because the country is finally on the verge of making affordable, quality healthcare a reality for all if we lead the way with the right perspective, experience, and understanding of the details. I spent most of my life taking care of people- directly caring for them in times of crisis or need. My role was also to make sure that people have access to the resources and information they need to improve their lives. My goal in studying economics was to help determine the best ways to empower people. I have been keeping an eye on healthcare-services and health-insurance market developments for decades. For several years now I have been offering legislators constructive conversations and well-substantiated proposals to get us moving in the right direction. Some leaders show signs of being ready to stand up to corporate special interest groups to simplify this convoluted system in the best interest of Iowans and Americans- though from my perspective, too many are dragging their feet. We now have a historic opportunity achieve long-awaited changes that will be more effectively negotiated and enacted by Congress with the right leadership from Iowa’s first independent U.S. Senator.

If the link between health insurance and our employers ends, most of us will still have private health insurance and many of us could even continue to be insured by the same company- the difference is that YOU will be in the driver seat. You would be able to select your policy in an easy-to-understand, consumer-focused, competitive (among insurers and service providers competing to provide the best service) market, so bye-bye insurance monopolies and complicated networks and-hello reasonable premiums! We now realize that health insurance provided by employers is not really insurance- since most people who have gone bankrupt due to healthcare costs originally had employer-sponsored health insurance when they first became ill or injured.

The quality of your health insurance policy should never have depended upon the size and commitment of any employer! When insurance companies have to scramble for each and every one of us from a statewide (or larger) pool instead of negotiating with employers for baskets of members, then competition and choice will have a huge impact on premium prices and affordability. Individual private health insurance markets would serve us all profoundly better if we all left large group/employer insurance behind. Not only are separate markets not equal when it comes to fairness, but many who have employer-sponsored health insurance (considering themselves the haves- as opposed to the have-nots) are under the illusion they are getting a better deal than they actually have been, or could! If you really understand what goes into determining health insurance premiums, than you know that using employers to put people into groups to pool risk and determine costs is bad for consumers when that risk could be spread over larger groups (statewide or large rating areas for big, populous states, or even regional or national risk pools) with administrative costs could be significantly reduced.

Did you know that the federal government gives corporations tax breaks to select and manage your health insurance for you? (State governments double this mistake.) How about you get the tax break instead? That means you would deduct the cost of your own health insurance from taxable income in order to choose an affordable, quality policy from a well-regulated health insurance market with all good choices.

The choices will be better and more affordable because finally health insurers will have to answer to you- the consumer, and be forced to operate in a competitive, transparent, consumer-focused, well-regulated U.S. health insurance market.

Big insurers (that hold monopoly status in health insurance markets) and big corporations (which enjoy having the federal government subsidize their benefits to employees) will resist change, but Obamacare’s 2010 concessions to them can be the last. Lobby groups were allowed to protect the failing, unfair, large-group health insurance market model that keeps our healthcare system so void of any consumer input, and so complicated, and so costly! Insurance companies (and other 3rd-party negotiators like “pharmacy benefit managers”) have been enjoying a heyday at the expense of Iowans and Americans. (see Economist article: “Which firms profit most from America’s health-care system”- links at end of section)

The old employer-provided health insurance model is detrimental to our economy and harmful to us all. Here are only some of the reasons why:

Downward pressure on workers’ wages, especially for low-wage earners. As healthcare costs have risen while remaining part of employee benefit packages, employers have been unable, or not incentivized, to increase wages.

People stay in the wrong job for too long or don’t find the best applications for their skills and talents when they are burdened by health insurance concerns linked to employment.

Business owners are burdened with unnecessary administrative costs, wasting time and resources to serve as provider of healthcare coverage to employees. Businesses should be able to focus optimizing on their intended objectives- we don’t need them involved in the business of health-insurance negotiations as well.

We all know this convoluted system has too many moving parts that need to be dismantled if we expect to move forward. Small to medium business owners will be delighted to lose all those silly number-of-employee and small-group-plan schemes so that their business will be free to develop in its own best interest and in the best interest of its employees. They will be free to offer more direct benefits that impact every employee regardless of health status- like better pay, better working conditions, flexible schedules, or more generous paid time off.

States can have some options for implementation, but the Federal government has to set the stage. Iowa achieved theleast of all50 states in realizing the benefits offered by the ACA and its potential to establish a thriving individual health insurance market. Most of that is the fault of our state government legislators and insurance regulators. Big health insurers (like other corporations) can be expected to operate in their own corporate best interests- sometimes over the best interest of consumers. It is the government’s job to set the rules, protect consumers, and maintain a fair playing field among insurance providers to prevent monopolies. We have learned a lot from how the states implemented the ACA differently – some resulting in much more affordable access to quality health insurance in the individual market compared to others. Now we know what next steps should be promoted on the national level to make even more dramatic improvements for all.Example of such observations- https://www.commonwealthfund.org/publications/maps-and-interactives/2019/apr/what-your-state-doing-affect-access-adequate-health?redirect_source=/publications/maps-and-interactives/2019/jan/what-your-state-doing-affect-access-adequate-health

Individual health insurance markets throughout the nation will work profoundly better for all when they are consumer-saturated, or flooded with people previously stashed-away in employer-sponsored plans. Much of the complicated legislation in the ACA was dealing with the fact that individual markets throughout the nation only contain a minority of healthcare consumers, which does not make for a market that is easy to estimate average cost of coverage, or effectively distribute risk for lowest premiums. So ACA adaptive schemes like “risk adjustments” and “risk corridors” were necessary to sustain a market where insurers could effectively operate. Those schemes would be far less necessary in a truly consumer-saturated market.

Minimizing or eliminating any rural disadvantage when it comes to healthcare access and affordability will be easier once we make the transition I propose. When all Iowans and consumers are in the same market, we will have access to similarly affordable premiums and rural hospitals and healthcare providers will receive more payments from multiple higher-payment-rate insurers. (Some of the details get a little complicated – but that’s where I come in with the knowledge to help develop and defend the meaningful changes that will have the most immediate impact on our lives! Consider a chat with me sometime if you want to understand how things like how a state defines “rating areas” makes a big difference. This is one area of legislation where the federal government can set some basic standards to help states stand up to insurers to support rural communities and keep costs fair no matter where you live).https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/ia-gra.html (Iowa has 7 rating areas, but for its population and size we should only have 3 at max- or better yet, none. With my proposal big health insurers won’t get the upper-hand in defining them and would not be able to coerce state insurance regulators.

The transition to this new, much-more-functional private health insurance market also means no need for any individual mandate or “responsibility payment” like the one just dropped by legislative changes in 2019. You will likely be much more enthusiastic about choosing private health insurance when you have access to clearer information that is easier-to-understand, and find than it is your car or homeowner’s insurance. You will be able to select your policy from a simplified, properly-regulated, transparent, health insurance market that offers you the coverage you need at a much more reasonable price. The employer mandates end with this plan as well (since your employer should never have had anything to do with such personal matters as choosing your health insurance in the first place).

No one should have to go medically bankrupt, or be earning subsistence-or-lower-level income to get access to publicly-funded healthcare services. If for any reason there is still not enough economic incentive to get insured in the new, more-affordable, high-quality private health insurance market, a reasonable payment will be required to access Medicaid services for any year anyone of any income level require them (for those who don’t already qualify for Medicaid). The amount any individual would pay for Medicaid services would be based on a reasonably-low percent of annual income and coverage would be retroactive to the start date when the initial costs were incurred for the year. Does that sound fair? (No matter what your take on this proposal detail I want to hear from you!)

The Patient Protection and Affordable Care Act of 2010 (ACA or “Obamacare”) was for the most part effective legislation with many steps in the right direction. Yes – more people have health insurance. It invested in a system where consumers have access to more information and simplified descriptions of confusing health insurance policies. In my work I have directly observed its more meaningful positive impacts. Because of the PP-ACA, there are even more incentives for hospitals to prevent complications, our chronic diseases are more likely to be managed effectively, and unnecessary yet costly tests and treatments are less likely to be done at our expense.https://www.ced.org/blog/entry/top-healthcare-stories-for-2016-pay-for-performance. The legislation was extensive and far-reaching. Many are unaware that important protections were gained even for those with employer-sponsored insurance plans. https://www.healthaffairs.org/do/10.1377/hblog20170111.058297/full/. ACA legislation even initiated a program that improves the likelihood that older Americans will be able to stay in their homes and receive the medical assistance they need, if they prefer that option over having to go into a nursing home for care. (Yay for Iowa being one of 18 states to participate in this important ACA provision- the Medicaid Balancing Incentive Program! https://www.kff.org/medicaid/report/medicaid-balancing-incentive-program-a-survey-of-participating-states/

*No major legislation is perfect and most end up with some unintended consequences (Subsidizing and facilitating a rapid transition to the use of electronic medical records is one area that didn’t work out as smoothly as intended. In some cases, not only did it not improve efficiency of care, but it actually ended up distracting doctors and healthcare providers from being able to focus on caring for patients as well as they could before.) I am eager and prepared to tackle such problems in the senate as necessary to keep our healthcare system improving with great momentum! http://fortune.com/longform/medical-records/.

The PPACA was more costly than it should have been because of work-arounds with high administrative costs that only served to prop up a broken employer health insurance market model. Monitoring, reporting, and collecting the individual (“shared responsibility provision” fees) and employer mandates incurred high administrative costs. Standing up to health insurance lobbyists and large corporations that benefit from our broken system would have been profoundly more cost-effective. The big step backward with the passage of the ACA was its propping up of employer sponsored health insurance just as we were starting to break those shackles. If left the majority of healthcare consumers in the convoluted, complex system of large group/employer insurance where big insurance and other middle-men negotiators could continue to control our costs. This also prevented consumers from flooding into the individual market where transparency and competition among insurers would have lowered costs. It’s time to learn from this grave mistake!

My proposal would serve Iowans, Americans, and our economy better than single payer or “Medicare for All” proposals – what’s more, it would happen more quickly to immediately provide relief! I want to empower you by taking the power away from big insures and corporations. The next step then is NOT to create a high-administrative-cost and inefficient government payment and pricing model that continues to deny consumers input. Our country has yet to experience what it would be like if the government simply did what it is supposed to do with the health insurance industry: 1- Set a fair playing field that offers fair premiums to all consumers and limits monopolies, 2- Protect and empower consumers with good information, enforcement of regulations, and economic incentives to make good choices 3. Stop giving tax breaks to employers to get in the way! The health insurance industry can serve us reasonably well if government fixes for the glaring market failures that have been overlooked for decades are finally tackled.https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-health-spending-growth-has-outpaced-growth-of-the-u-s-economy_2017 (Wonderful simple colorful charts to give you the big picture!- “How has U.S. Healthcare Spending Changed Over Time.”)

There are a lot of great solutions out there to learn from, but our combination will be unique.

Taxpayer dollars will have much more impact if they are reserved to maintain the fair playing field, support and improve the public payment plans that we already have (with additional support from consumer access payments), and offer other new supportive provisions. Federal re-insurance programs to support cost extremes or outliers, collaboration with disease foundations, and public-private partnerships could offer us much better healthcare bang for each tax-payer buck. The ACA subsidizes premiums for low-wage earners and in doing so has been paying more than our government should for overpriced premiums that would be lower once we change the health insurance market model. This part of the legislation could continue subsidizing fewer premiums that are more reasonably priced. We can also keep people from falling through the cracks by increased access to our public programs- like Medicaid (as previously described). A Medicare buy-in for people over age 50 or 55 could also be considered, though many more people in that age-range may already be very satisfied with the quality, affordable private health insurance newly available with this plan.

The bold-but-practical market-model change of this proposal is urgently needed and offers more immediate, positive impact than any other candidate’s plan. It untangles the currently convoluted payment and access-to-service system in a few simple steps to immediately provide relief to Iowans and Americans- and what’s more- there is plenty of middle-ground here to get it through Congress with bipartisan support! Insurance companies see the writing on the wall with people frustrated and crying out for Medicare for all. I believe this is the only way forward to give the health-insurance industry one last chance and realize its positive potential. WE as healthcare consumers will have the market-power impact to make healthcare services and the health-insurance system work as they should. The healthcare industry employs more people than any other in our country. Even though some in the industry are overcompensated, many healthcare workers or care providers are underpaid (I have personally experienced both sides of that issue ;-)). We need to make sure that essential service facilities throughout the country are supported and able to provide quality care. Elect me to fix what’s broken now. Regardless of where you envision us ending up for good of Iowans and Americans, I know this is now the right direction forward.

Enjoy other great links and resources to help you understand the facts on the ground, and to get you excited about more positive changes we can realize together:

An analysis of how different states implemented the 2010 PP-ACA and what we can observe. Some states did much better than others by taking advantage of the many implementation options and experienced less than half the rate of insurance premium cost increases.

(Recommended reading*- an easy-to-understand resource that offers some history, fairly current observations, and meaningful explanations for why the primarily employer-sponsored health insurance system in the U.S. so detrimentally fails us all:

About healthcare “middle men” and the profits they sponge up with an analysis of monopolies: “In the case of health care, consolidation has probably made things worse by muting competition. There are now five big insurance companies, three big wholesalers, three large pharmacy chains and three big benefit managers.” (Here in the U.S.)